Smoking Cessation and Traditional Chinese Medicine
Stopping smoking could be one of the hardest things you will ever do. The addiction to nicotine is one of the strongest. Stopping smoking now is one of the best things you could possibly do to improve your health. The power of the lungs to regenerate themselves is almost limitless.
drawing by Justin Bean
If you have been smoking for a few years or several decades, stopping smoking will improve your health dramatically. Most people attempt to quit many times before they are successful. They try to quit smoking and fail and then try to quit smoking again only to fail again. What are the consequences of these attempts? Most people quit trying. Imagine the type of person that repeatedly tries to accomplish something only to fail. That takes guts. How many of us have the fortitude to keep trying? I suggest to my patients that attempting to quit smoking is a process and not an event. It takes time. Not only do you have to decide to quit smoking, you have to decide again and again. Morning, noon and night, through good times and bad times, you have to decide to quit, and then stay quit. Unfortunately your brain, the tool that you use to make your decisions, cannot be trusted.
Since the ability of the brain to stick to a decision is compromised by taking drugs, you cannot count on your brain to do as it is told. It can be very difficult. The road to success may have bumps along the way. I suggest that when a patient smokes while attempting to quit they think of it as a slip. Anyone can make a slip. The trick is to get right on track again. Instead of imagining that you have failed, you just redouble your efforts to succeed. Understanding the physiology of addiction can help the patient understand what they're going through and why. The process of unaddicting yourself is called withdrawal. Withdrawal is associated with several unpleasant symptoms. Craving more cigarettes is the most common symptom of withdrawal even though it's a process that involves the entire nervous system.
All nerves have a beginning and an end. A nerve cell is like a long thin wire. The nerve cell carries an electrical signal from one end to another, like a wire. If I touch a hot stove with my finger, a signal is initiated. That signal travels up my arm until it hits the end of the cell. At the end of the cell is a small space. This space separates one nerve cell from another. The medical term for this space is synapse. Synapse is Latin for space. Inside the synapse, nerves don't use of electrical signals, they communicate with chemical messengers. These chemicals are called neurotransmitters. Neurotransmitters exist in the synapse in a relatively delicate balance. When an electoral signal is initiated, that signal travels to the end of the nerve cell. When the electrical signal hits the end of the cell it causes neurotransmitters to be released into the synapse. If enough of these neurotransmitters connect to the special spots on the next cell, then the signal is perpetuated. If not enough neurotransmitters attach themselves to the next nerve cell, the signal ends there. If I touch a very hot stove and a strong electrical signal is initiated, when that signal hits the end of the nerve cell, enough neurotransmitters are released to perpetuate the signal. My hand quickly withdraws from heat. If I touch a slightly warm stove, the signal is much weaker and the hand does not recoil. In the peripheral nervous system the effects of drugs are less apparent than in the brain. You can't smoke enough cigarettes to make something warm feel hot. Nicotine is a stimulant. A stimulant increases the likelihood that a nerve signal gets through. Stimulants are chemicals that look like naturally occurring chemicals in the synapse. When the stimulants are released into the bloodstream they work their way into the synapse. Coffee, tea, tobacco or cocaine contain different types of stimulants, but they all work in a similar way.
A stimulant that finds its way into the synapse of the nerves occupying the peripheral nervous system will not increase the intensity of sensation. They are usually not strong enough to cause increased sensation. The exception to this would be after having too many cups of coffee and getting all tingly or twitchy. It is in the brain where stimulation of the nervous system has it's most profound effects. In the brain, even small amounts of stimulants will change the way we feel by encouraging more signals to get through. Depressants have the opposite effect. Depressant chemicals make the signal less likely to perpetuate. Depressants reduce the likelihood that one nerve will communicate with another nerve. A drunk person leans on a hot stove until their hand becomes burned. The depressants in their nervous system inhibited their brain from feeling the pain as quickly. Whether it's a stimulant or a depressant, a chemical is considered a drug when it can enter the synapse and effect the function of the nerve. Drugs have only a temporary effect on the nervous system. Most drugs are cleared away by the detoxification system as soon as the body is capable. Nicotine is a highly toxic substance that the body will excrete very rapidly. Drugs that are quickly metabolized are more likely to cause addiction.
If the drug remains in circulation for a considerable period of time, the nervous system gets used to it being there. The nervous system will adapt the amount of neurotransmitters it creates with the assumption that the drug will be present. If the patient attempts to reduce using the drug, the nervous system is thrown into turmoil. The neurotransmitters in the synapse have become out of balance. The symptoms associated with this turmoil are termed withdrawal. The main symptom of withdrawal is the craving of the missing ingredient. Smoking cessation tools that contain nicotine are designed to reduce this effect. The brain understands that the chemical it needs comes from smoke. If the patient administers nicotine through gum or a patch, then the attachment to cigarettes can be broken. The brain will continue to get the nicotine it craves without smoking. As a result, when the patient reduces their exposure to nicotine, they crave only more gum or more patches and not tobacco. The patches contain less and less nicotine, so the longer you use them, the less nicotine goes into your body. Nicotine replacement products are an important tool in smoking cessation. Unfortunately for many patients, more help is needed.
Withdrawal symptoms are highly variable. Different people suffer in different ways. Women and men withdrawal in different ways. Physical symptoms tend to resolve first. Emotional symptoms tend to persist. Some patients report experiencing cravings for years. Weight gain is the symptom most commonly feared among smokers. Stopping smoking will cause weight gain. It is almost impossible to maintain your exact weight while withdrawing from a stimulant. A stimulant will tend to lower your appetite and increase your metabolism. Stimulants are the only substances that have this effect. No herb, supplement or medication will boost metabolism other than a stimulant. All stimulants are harmful to the body. All stimulants tax the ability of the body to detoxify.
The most commonly used stimulants are caffeine and tobacco. Both of these naturally occurring plant substances are widely used throughout the world. Both are associated with the workplace. Employers love stimulants because they believe it makes their employees work harder. Employers often provide stimulants to their employees. Caffeine has been shown to have similar effects as fear. Fear causes adrenaline to be released by the body. Adrenaline is our natural stimulant. Caffeine has similar properties to adrenaline. The daily use of caffeine has not been associated with the types of negative effects from other stimulants. Many people drink coffee or tea. It doesn't kill you. Some find the stimulating quality of caffeine unpleasant while others note improved concentration, wakefulness and appetite suppression. Drinking too much caffeine gives you a perfect example of what it feels like to stimulate your nervous system. All of the most commonly used drugs occur naturally in plants. Tobacco produces nicotine. Nicotine prevents the tobacco plant from being consumed by insects. Nicotine is a very powerful poison often utilized in insecticides. If a small insect attempts to ingest a tobacco plant, nicotine enters the insect's nervous system causing it to malfunction. If we ingest very small amounts of nicotine it affects our nervous system. Smoking tobacco releases the nicotine from the plant and allows it to be absorbed through the lung. The first time it' s ingested nicotine often causes the person to feel ill. Over time the person feels ill when they don't have nicotine.
The idea of using acupuncture to reduce the symptoms of withdrawal originated early in the history of acupuncture. It was the 17th-century, and the British had a rather nefarious trade. It was called the" East India tea Co." but it was really an opium company. The British used to buy opium from Afghanistan (where it is still being produced) and transport it to China. They set up what were called opium dens. These were opium selling places. The British would do things like kidnap a Chinese kid and force him to smoke opium under pain of death. After successfully addicting the kid, they told him if he wanted more opium he had to to bring back more kids. It was quite a business proposition they had and one can only imagine the carnage it caused. It didn't take long for the Chinese authorities to want to try to eliminate these business practices. They enacted a series of laws which they copied from the laws that were in place at the time in Britain. Basically opium would be sold with a prescription. One had to go to a doctor, get a prescription and then buy your opium from a regulated source. This is the way opium was sold in most of Europe at the time. The British decided this was an unfair trading restriction. They used their superior naval power to defeat the Chinese militarily and force them to keep the opium dens opened. A series of wars were fought called the opium wars.
During this time most of China's wealth was drained by the colonial powers. The central Chinese government was weak and ineffectual so the common people began attempting to apply their traditional medicine for the purpose of freeing the population from addiction. Acupuncture and herbal medicine are still widely used in the treatment of opium addiction. The National Acupuncture Detoxification Association has trained thousands of technicians to treat drug abusers associated with the criminal justice system. These programs dramatically reduce the rate of recidivism. We could consider anyone who needs to use a drug, an addict. No one wants to be called an addict. Characterizing the sellers of drugs and the users of drugs varies according to one's perspective. The sellers of drugs always called the users of drugs addicts. They like to promote the idea that anyone using a drug is immoral. They would just as soon blame the drug user for their addiction. The sellers of drugs, like the East India tea Co., often promote the idea that the users of drugs are weak willed and deserving of their fate. They justified their dirty business by explaining that the Chinese were more likely to become addicted to opium due to the fact that their moral character was insufficient. Never mind that at the time, the president of the United States happened to be addicted to opium, as was the pope.
The sellers of drugs routinely lie, cheat and kill in order to sell their poisons. Whether the drugs are legal or illegal we hear the same excuses from the pushers. They sell their products, but take no responsibility for their effects. Those of us in the medical system have another view. We see addiction as a medical condition. We know that any living thing can be addicted to any drug. We understand that the human being suffering from this medical condition requires treatment. Moral considerations and judgments have no place in the treatment of addiction. The patient must be educated about their condition and then given the tools to recover. One such tool is acupuncture.
The traditional Chinese medical system is based upon the concept of balance. When the body is in balance, the individual is healthy and feels great. If the system becomes out on balance, symptoms result. Consistently taking a drug encourages the nervous system to create a new balance. Abruptly stopping the drug upsets that balance. Acupuncture is a medical intervention that attempts to achieve balance. Acupuncture often helps the person feel better instantly, although the effect tends to be temporary. Over time the body will create neurotransmitters in the appropriate amounts. Eventually the symptoms of withdrawal diminish and resolve. It is during the period of withdrawal that the risk of recidivism is greatest.
I have described the cravings of withdrawal as similar to the concept of having wild horses pull you to smoke. You would have to dig your heels in the dirt to prevent from being pulled along. In order to successfully prevent yourself from continuing to smoke a conscious decision must be made not to smoke. That conscious decision must be maintained at all times. If the decision becomes weakened by a lack of resolve, the wild horses will pull you along. The image of digging your heels in the dirt to prevent from being pulled along is quite accurate.
The main problem with achieving success easily is that the brain itself cannot be trusted. The brain will always try to find excuses to smoke. Many patients have told me how they go to a convenience store every morning. They used to go to the convenience store to buy coffee and cigarettes every morning. Some have termed them Nick and Caff (nicotine and caffeine). Anyway they are waiting in line for their turn to pay, they are holding their coffee in their hand and as they move forward in the line they might be thinking of something stressful or maybe they're just distracted. They continue on their way to leave the store and find that they have purchased a pack of cigarettes. They didn't mean to get the cigarettes. They did not want to get cigarettes. But because they weren't consciously deciding at that moment to not get cigarettes, their brain decided for them. Now they have a new pack of cigarettes in their hand and it's much harder to not smoke them, then if they had left them at the convenience store. At the crucial moment when it came time to decide whether or not to buy cigarettes they failed to keep their heels dug in. They were pulled along. Their brain decided by default it wanted more cigarettes, and so it asked for them. Addiction was once described as a monkey on your back. I would suggest the image of a monkey in your brain.
The Chinese identified various emotional states that would render the patient more or less likely to break the addictive cycle. On one side we have the emotions associated with optimism. Optimism, in a nutshell means feeling positive about things. If you are optimistic and you don't want to smoke, it's because you want to protect your body from it' s harmful effects. An optimistic person feels good about themselves and their body and would not want to do anything that might injure themselves. An optimistic person would not want to smoke for the very best reasons. Unfortunately it is difficult for most of us to maintain an optimistic outlook. We live in the modern world where negative information is widely disseminated. We inhabit a consumer society where the overriding message embedded in our entertainments is that you can't be happy unless you buy more meaningless stuff, meanwhile people die because they don't have the necessities of life. It is hard to always feel good about the world in which we live. That makes it hard to always feel good about ourselves. An optimistic outlook is a delicate thing, the world in which we live is crushing. The opposite of optimism would be pessimism. Pessimism, in a nutshell means it doesn't matter. As soon as you think it doesn't matter, it becomes almost impossible to stop yourself from smoking. Your body and your brain want you to smoke. You have to physically and mentally stop yourself from doing so.
If you become pessimistic, even for short period of time, the basis upon which you build your ability to withstand your cravings is sapped. If you think it doesn't matter, you won't be able to muster enough gumption to stop yourself. If you think it doesn't matter, you can't stop the wild horses from pulling you along, forcing you to smoke. Pessimism and drug use go hand-in-hand. Luckily there are more than two emotions available to human beings. One particular emotion appears to provide strength to the individual. One emotion can be called up at will. That emotion is anger. Anger is very powerful. Anger gives the individual strength. Anger is impervious to pessimism. Even if you think it doesn't matter, you can still get angry. Anger and indignation work hand-in-hand to help smokers quit. We all have friends that used to smoke. They were always so mad about smoking. Why is this? Because anger was the strength that they used to quit. Anger is a tool that can always be called up and manipulated, this is how.
We wouldn't want you to become angry with your loved ones or coworkers, that might be counterproductive. We want your anger to give you the strength to quit. Anger is a tool that you can use. I would like to paint a picture of a particularly loathsome individual. I call him the tobacco executive. This is the lowest form of life on our planet. These are the people who have injured and killed our loved ones. The tobacco executive makes money by addicting children to a deadly product. This is the most disgusting business since the East India tea Co.. Children are the only people pliable enough to be encouraged to smoke cigarettes. I have never in 10 years had a patient report that they began smoking as an adult. Every single individual started as a child under the age of consent. This is the way tobacco addiction is accomplished. The tobacco executives hired advertising agencies to craft incipient methodologies for encouraging children to smoke. The tobacco companies were directly responsible for the production and marketing of candy cigarettes. The tobacco companies tested cartoon characters on children in order to determine which characters were most effective at promoting their deadly products. The tobacco companies made sure that their cartoon characters appeared on billboards surrounding schoolyards. They insured that tobacco products could be sold at vending machines, bypassing state laws requiring proof of age.
The tobacco companies manipulated the amount of nicotine in cigarettes in order to more completely addict their customers. In a particularly loathsome way, they increased the amount of nicotine contained in light brands. These light brands of cigarettes are purposefully mislabeled in order to mislead their customers. The tobacco executives knew that people switched to lighter brands when they attempted to quit smoking. So putting more nicotine in lighter brands prevented people from being able to quit. Purposefully mislabeling lighter brands hid this technique for many years. The tobacco executives did all of these things and much more in order to increase their profits. Make no mistake, tobacco products are the most profitable products ever devised. Tobacco is extremely cheap and easy to grow. No insects will eat it. A few tobacco plants will produce enough cigarettes to last most smokers a year. Tobacco is the original cash crop. The tobacco executives counted up their obscene profits and decided they wanted more.
The carnage to our society that results from tobacco addiction is difficult to fathom. Large numbers of dead people are difficult to imagine. We can talk about tens or hundreds of thousands of people but we don't really understand what that means. Tobacco is responsible for the deaths of more Americans than any other single factor. In our society we have a tendency to respect the sacrifice made by our Armed Forces. Many Americans have lost their lives in foreign wars. The numbers of Americans killed by tobacco dwarfs this sacrifice. We could start counting at World War I. We add all of the American casualties of World War I to World War II. We then add the casualties that resulted from the Korean conflict, the Vietnam police action, Gulf war one and two, the attacks of September 11 and every other war that occurred in that time period. All of the Americans killed by war since world war one do not equal the amount killed by tobacco in one single year. Let me repeat that in order to make it very clear. More Americans are killed by tobacco each and every year, than in all the wars going back to World War I combined.
That is a staggering number. These are not elderly people waiting to die from some other disease. We are talking about young, vital, productive Americans cut down in the prime of life, often by the most agonizing ways, and leaving loved ones behind. We have a tendency to hold a grudge against those responsible for killing our people. The Nazis were considered very bad people. Communism was something we felt had to be contained. The individuals responsible for the attacks of September 11 were described as cave dwelling religious fanatics. Nazis, Communists or jihaddists are a pathetic bunch. We might consider them brainwashed and even though we tend to characterize them as loathsome, they did what they did for an ideology. They believed what they were doing was correct. They followed their Fuhrer or their spiritual leader blindly like brainwashed robots. It was important for the free world to unite and oppose them. We all agree that the men and women who died fighting these ideologies should be remembered and honored. The instigator's of these discredited ideologies must be opposed as long as their methods involve the killing of innocents and yet they do not hold a candle to the evil associated with the tobacco executive.
The tobacco executive willingly pushed his fellow Americans into an early grave. He did this for pure profit. He was already so rich that it's beyond belief. But he wanted more. He does not kill for propaganda or religion but for profit. He does not kill a foreign, evil adversary but his fellow Americans. The tobacco companies became so rich that they bought all of the food companies. They bought all of the pharmaceutical companies. They bought all of the media companies. They own all of it. They want more. I suggest to my patients that they call up the image of this despicable character every time they think of smoking. I advise them to allow themselves to become angry at the injustice done to them. I suggest that their withdrawal symptoms are a direct result of this tobacco executive' s machinations. I suggest that they recall a loved one who suffered greatly before succumbing to tobacco related disease, and blame the tobacco executive. I want them to practice getting mad. This is a type of intellectual anger. It's not real anger directed at a real person standing in front of you, it's a technique to encourage you to dig your heels in. Imagine that if you don't smoke, the tobacco executive loses money. Since money is the most important thing to them, when you don't smoke they lose. Every time you buy tobacco products you put money in their pocket. Imagine a greedy, greasy executive type wearing a $1000 suit hopping on his private plane to jet off to his fourth home in some exotic location. This image was similar to that which the Chinese used to help their population get off the opium. They argued that the British brought the opium here. They said to use opium was to enslave yourself to foreigners. To kick the opium was to emancipate yourself. During the most difficult process of withdrawal, attaching the use of the drug with an image of evil is helpful. But in the weeks months and years following, that image is essential.
It is common for people to forget how difficult stopping smoking was. The brain will never forget how much it wants to smoke. Many patients have described experiencing cravings for tobacco many years after having successfully stopped. Those patients who slipped and began smoking again were often caught unaware. They might have undergone a stressful time. Some patients described having slipped during celebratory times. Most patients will offer an excuse as to why they started smoking again, none of them wished to become addicted again. Keeping in mind the image of this disgusting salesman, rich beyond avarice, rubbing his greedy hands together waiting for you light up can prevent the slip. Unfortunately just trying one cigarette will often result in demoralization. Remember if you slipped, you're going to get right back on track. If you accidentally bought a pack, nothing is more therapeutic then ripping up those cigarettes and throwing them in the trash. Wow, all that money right in the trash. That's powerful. It becomes difficult to buy another pack after you have thrown a few of them away.
Acupuncture has been reported by many patients as helpful to the process of quitting. Acupuncture is applied once or twice per week in order to reduce the symptoms associated with withdrawal. Acupuncture of the ear is most effective for this purpose. An acupuncture point located on the ear has been termed Spirit Gate. The point is described as calming. The point, when stimulated, produces a calming, relaxing effect. It can calm cravings. It can calm anxiety, sleeplessness or irritability. Patients receive a small needle that they go home with. It's a small needle attached to a piece of sterile tape similar to a Band-Aid. The needle is placed on the calming point, and the patient can activate the point anytime by pressing it. In this way the patient is given a modicum of control over their emotions. The ability to calm down an unpleasant sensation will allow many patients to resist smoking resumption. Over time the craving for cigarettes becomes less intense. The acupuncture point on the ear is replaced as necessary. Patients have been successful quitting smoking after anywhere from two to 20 visits with the average number of visits 10. When pressed, the needle creates a sensation in the ear. This sensation can be similar to a small pin prick. If this sensation becomes too intense or if the needle begins to become irritated, it should be removed. This is done very simply by peeling away the tape that holds it in place. The needle is a small, sterile, surgical steel spiral. If the area around the needle were to become red, painful or inflamed the needle should be removed. Serious negative reactions to ear acupuncture do not occur.
In some cases acupuncture is insufficient to reduce the symptoms of withdrawal. Acupuncture simply is not strong enough to work. In those cases I suggest a multidisciplinary approach. The combination of nicotine substitutes, cognitive therapy, medications and hypnotism is more powerful then any single therapy used alone. Groups have sprung up modeled after the programs utilized for narcotics addiction. Often hospitals sponsor groups like nicotine anonymous. Whatever the method, smoking cessation is the most important goal one can set. Whatever your current medical condition, stopping smoking now will instantly improve your health and vitality.